Deep margin elevation in posterior composite part II

 

Deep margin elevation in posterior teeth.

Article info.

Keywords:

-        Deep caries.

-        Deep margin elevation.

-        Split dam.

-        Soft tissue management.

 

Abstract

 

·       Deep margin elevation is a conservative (Minimally invasive) technique used in deep proximal caries to relocate sub-gingival margins more coronal (supra-gingival) using different materials to facilitate (isolation, Matrixing), enhance marginal integrity, improve bonding strength and restoration durability.  

·       It could be a less invasive alternative to more invasive techniques like Crown lengthening and surgical extrusion. Deep margin could be restored by either Direct or Indirect restorations. Depending on the ability of (Isolation of the margin) & (The remaining tooth structure).

·       In case there is a massive loss of the tooth structure and cannot be restored by direct restoration, the tooth should be restored by Indirect Restoration.

·       It may be very challenging to restore the tooth with indirect restoration because of the cavity preparation, impression taking, the adhesive-bonding procedure, and proper moisture control may be interfered. 

·       These challenges are usually overcome by crown lengthening procedure.

Case scenario:
 

Ø  In this case scenario you will see a fully detailed steps of restoring a tooth with deep caries by (Indirect restoration).

 

Fig.1

 

A middle age male patient presented to our clinic complaining of severe pain from upper left posterior area, after clinical & radiographic examination we found a very deep recurrent caries under an old amalgam restoration, after removing of the old restoration, Teflon material was placed mesially to expose the deep margin.

 

 

Fig.2

 

After removing the old restoration and the caries, rubber dam isolation was done then Deep caries diamond wedge (which is has a deep curvature) was placed mesially to expose the margin.

 

Fig.3

After elevating the margin, air abrasion was used then buildup of the tooth was done using composite filling material (regular composite restoration steps as we mentioned before here), then the preparation for the indirect overlay was done, after that impression was taken to fabricate the final restoration.

Fig.4

 

First, the rubber dam was placed and the try-in was done then cementation of the overlay with the regular steps of cementation (Etching with hydrofluoric acid then application of the adhesive agent).

Fig.5 & Fig.6

Final restoration with 6 years follow up.

 

Case done by Dr/ Abdelrahman Ahmed Tawfik.

Article by Dr/ Amira Mohamed 

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